维持性血液透析患者心脏瓣膜钙化与左心室肥厚相关因素分析

The prevalence of cardiac valve calcification and left ventricular hypertrophy in hemodialysis patients

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者心脏瓣膜钙化与左心室肥厚相关影响因素。方法随机选取沈阳军区总医院血液净化科199名MHD患者(男性119名,女性80名)。入选标准为:血液透析3次/周,每次4h;年龄在18~75岁;透析年限6个月以上,10年以下排除心脏瓣膜病变患者。超声心动图检测患者主动脉钙化、二尖瓣钙化、左心房内径等。化学发光法测定血清全段甲状旁腺激素。结果左心室肥厚患者较无左心室肥厚患者发生瓣膜钙化比例高(c2=9.534,P=0.002),白蛋白水平低(t=2.814,P=0.035)。心脏瓣膜钙化的患者年龄高于无瓣膜钙化者(t=5.060,P=0.001),收缩压较无心脏瓣膜钙化患者高(t=3.012,P=0.032),发生左心室肥厚比例高(c2=9.534,P=0.002),白蛋白水平低(t=2.031,P=0.025)。LVMI与白蛋白(r=-0.238,P=0.015)、LVEF(r=-0.360,P=0.001)呈显著负相关,左心室心肌质量指数与收缩压(r=0.229,P=0.005)、舒张压(r=0.305,P=0.003)呈显著正相关。年龄、糖尿病病史、收缩压、白蛋白水平是心脏瓣膜钙化的独立危险因素。结论 MHD患者心脏瓣膜钙化与左心室肥厚具有密切关系,良好的血压控制及营养状态可能对于延缓二者的发展具有重要的意义。

Objective To investigate the prevalence of cardiac valve calcification（CVC） and left ventricular hypertrophy（LVH） in maintenance hemodialysis（MHD） patients. Methods A total of 199 MHD patients treated in Hospital of Shenyang Military Area Command were randomly selected. They were 18- 75 years old without heart valve diseases, and were treated with hemodialysis 3 times/week and 4 hours/session for 6 months- 10 years. Aortic valve calcification（AVC）, mitral valve calcification（MVC）, left atrial size（LAD）, were measured by echocardiography. i PTH was determined by radioimmunoasssy. Results Patients with LVH had higher rates of CVC（x^2=9.534, P=0.002） and hypoalbuminemia（t=2.814, P=0.035）. Patients with CVC had higher systolic BP（t=3.012, P=0.032）, older age（t=5.060, P=0.001）, and higher rates of LVH（x^2=9.534, P=0.002） and hypoalbuminemia（t=2.031, P=0.025）. Left ventricular mass index（LVMI） was negatively associated with albumin and LVEF, and was positively associated with systolic and diastolic BP. Age, diabetes history, systolic BP, albumin were the independent risk factors for CVC. Conclusion CVC is associated with LVH in MHD patients. Control of hypertension and maintenance of an adequate nutritional status may delay the processes of LVH and CVC.